Given its huge value to our society, the NHS is an institution that should live and breathe Abraham Lincoln's famous democratic dictum: "Of the people, by the people, for the people."

Today, the government begins a debate about how we achieve this in practice. Our consultation, Local democratic legitimacy in health, is a grand title for a simple question: how do we ensure the NHS better serves and accounts to the public for the money it spends and the results it achieves? In other words, how does the government's localism agenda fit the NHS?

This is a question being asked across government – and rightly so. Dealing with the deficit legacy will involve tough choices. If we want to do this in the fairest way, then we need the public to be at the heart of the decision-making process.

The future of the NHS is a case in point. Our white paper frames this as a single, overriding principle for the NHS. The patient should always come first – or, to put it another way, "No decision about me, without me". So far, the spotlight has been trained on our proposal to transfer budgets to GP consortiums . I believe this is vital for shifting responsibility for the NHS much closer to the people who know us best – our local GP.

But it is only one piece of the jigsaw. What has been largely missing in the debate is the radical shift in accountability and oversight that supports this – something that will make it easier for all of us to shape and hold local health services to account in the future.

By stripping out political targets and replacing them with stronger "bottom-up" accountability structures, our proposals will move control out of unelected Whitehall and into the hands of elected councils and local communities themselves. Across the health service, governance through bureaucracy will now turn into governance through democracy – with new powers given to locally elected bodies to ensure the NHS is accountable to the public, and a stronger voice for people to give their verdict on local services.

Why does it matter? It matters because the old NHS has not always been as open as it could be. In changing local services, key decisions have too often taken place behind closed doors. In managing complaints, families have too often found their questions left unanswered. In answering to the community, the NHS has too often retreated behind its bureaucracy.

I speak from personal experience. Last year it took me five months to get the NHS to spell out how it had spent money on carers in my area – information that was vital for helping me to represent the interests of my constituents. I know I am not alone; across the country, the local NHS has lacked transparency and accountability for the choices it makes about services. This failure carries a huge price – anyone who suggests otherwise need only look at the history of Mid Staffordshire.

So the new NHS will be very different. We will pull back the curtains and shed light on all corners of the health service. Accountability will no longer only stretch upwards (rather obliquely) to Whitehall, but also outwards – clearly and tangibly – to communities.

Local authorities will take on a new role in making sure the NHS and GP consortiums listen to the public and are fully accountable for the money they spend locally. Councils will also regain control of public health for the first time in nearly four decades, and will help to fuse the strategy, planning and delivery of health, social care and wider public health services. This will be one system pulling together, not several pulling apart.

At the same time, the new HealthWatch England organisation will be a local consumer champion that will give voice to patient concerns. Greater choice and clearer information on local NHS services will also mean people can vote with their feet – a verdict infinitely more powerful than the 260,000 Whitehall data returns currently used to assess the NHS.

Some have suggested that removing top-down political targets are a licence for the NHS to drift backwards to the days of long waiting lists and poor services. They clearly haven't read or understood the white paper properly.

The new landscape of strong democratic accountability and partnership we are proposing will maintain the pressure to improve, but the pressure will now come from below not above. And this will ensure the NHS can finally focus on what the people want, rather than what the politician prescribes.